Risk Adjustment Implementation Analyst

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

The Risk Adjustment Operations Analyst is accountable for analyzing business practices and operational objectives, collecting stakeholder feedback, providing suggestions for improvement, and assist with developing strategic plans and roadmaps to support the department’s goals. They will conduct market research and evaluate market trends, document the practices and market behaviors of industry competitors, and create and present analyses to support Risk Adjustment or risk adjusted lines of business. This role is expected to interact at a senior level of the organization.

Responsibilities:

• Analyze key industry trends to develop a strategic point of view on current market position and the impact on specific projects and goals.

• Analyze existing risk adjustment processes and workflows, data and reporting, identify key individuals, and suggest opportunities for improvement.

• Create roadmaps for initiatives by assessing the business value, creating the plan and driving the appropriate execution and governance.

• Contribute to strategy development, analysis, and planning for achieving business growth and other strategic initiatives related to risk adjustment or risk adjusted lines of business.

• Monitor the long-term effects of strategies or initiatives put in place by the Risk Adjustment team

• Support the development of standard operating procedures and documentation for the risk adjustment department, including cataloging, developing, and maintaining existing processes. 

• Conduct research on market trends, new industry trends, legislative impacts, and other areas of impact on Risk Adjustment.  

• Collaborate with internal partners to identify, develop, and execute deliverables supporting risk adjustment strategies.

• Assist with the implementation and reporting on the Risk Adjustment department’s strategic initiatives.   

• Prepare analysis output, insights, and reporting for Risk Adjustment leadership presentations.

• Maintain an understanding and knowledge of the risk adjustment process, including regulatory changes impacting the program.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Requires a minimum of 3  years of experience in consulting or health care field or relevant field.

• Experience navigating matrix organizations.

• Experience working with and presenting to senior audiences is a plus.

Knowledge:

• Project management process and knowledge area.

• Proficiency in Microsoft Office tools; Expert knowledge of PowerPoint.

Skills and Abilities:

• Strong research skills.

• Ability to manage multiple projects through planning, organizing, and independently following logical priorities independently.

• Ability to recognize strategic needs, contribute to planning with research-based business recommendations, and generate alignment.

• Ability to work and collaborate with various levels of the organization.

• Solid understanding of management frameworks.

• Sound knowledge of financial or data analysis.

• Creative and strategic thinking.

• Excellent written and verbal communication.

• Strong communication and presentation skills.

Travel:

• Some travel may be required.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$77,900 - $104,370

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on infor